Friday, May 29, 2015

Ai-Jen Poo's The Age of Dignity: Preparing for the Elder Boom in a Changing America presents a vision that brings together the frightening facts of the Boomer generation's mass aging into an unprepared and uninterested society with a Millennial generation member's more consensus-based than conflictual understanding of how we might get from where we are to somewhere much better.

She starts from her own story of how she, her family, and a devoted paid caregiver are addressing the needs of her aging mother. And she shares the story of how her aunt represents a very typical example of the inadequate "system" that is all we have to meet the needs of our exploding population of elders. Here's a picture of what happens when care falls on "the sandwich generation."

The bulk of care falls on one sibling, more often a daughter than a son. Women make up two-thirds of today's caregivers. The average caregiver for an older adult is a fifty-year old woman who provides nineteen hours of care per week -- essentially a part time job -- for an average of four years. Even when other relatives are involved, they generally do less than 10 percent of the work. ...

"I keep praying, 'Give me more patience, give me more love.' I know this is only temporary." My aunt is really hard on herself when she catches herself thinking about the inevitable moment when her mother passes on and no longer needs care. In fact, spoken or unspoken, a desire for the elder or sick relative to die is incredibly common among family caregivers....

... As grueling as my aunt's situation is, it pales in comparison to many of the stories I've heard from family caregivers. After all, my aunt has managed to keep her job, is able to hire professional caregivers for her mother, even receiving some support from the state of California, and must only -- only! -- do that work herself on weekends. Millions of Americans are less fortunate than she....

This situation is clearly neither fair to her aunt, nor sustainable for society.

There is no question we are failing today's American families. Our current system is a holdover from another time, when life expectancy was about sixty years and dementia was rare. It's from a time when the society relied on the uncompensated work of women who didn't hold jobs outside the home. It's from a time when the national ratio of elderly to young workers was radically different, making a more balanced inflow and outflow of government dollars for social programs. ...

While the elder boom translates to a number of grave challenges for family caregivers, and for the sandwich generation in particular, it's important to understand that the impacts of providing eldercare are not all negative, not by a long shot. Alongside words like "grueling," "isolating," and "exhausting," I hear things like "rewarding," "life-affirming," and "healing." ... The more we practice being allies to seniors, people with disabilities, and those members of our communities who rely on personal assistance and care both in and outside the home, the more fully human we become.

Poo then shifts to looking at elder care from the point of view of the vast numbers of people who are paid professional care givers.

Undeniably, the work is rooted in relationships and emotions. One way of understanding this is that the basic values that define all healthy relationships between people -- respect, humanity, accountability, dignity, empathy, and compassion -- also apply here. Nothing about the relational aspects of caregiving makes it any less of a real job. Caregiving is most definitely work: physically strenuous, rigorous work that requires discernment and flexibility. As with all forms of labor, you put in a hard day's work and you expect to be appreciated and compensated. You strive to do better and learn more, and expect to advance over the course of a full career. You take pride in your work and expect to be able to support your family.

Domestic workers have always been treated as a "special class" of workers; they have been "specially" undervalued as workers and excluded from labor laws since the New Deal. ... A significant step forward was made in 2013, when, as a result of our and many other organizations' efforts, the U.S. Department of Labor released a regulatory change that narrows the exclusion of "companions" from the Fair Labor Standards Act, so that nearly 2 million home care providers and caregivers will be covered under minimum wage and overtime protections ... After seventy-five years of exclusion, we're finally beginning to recognize and establish basic protections for care work.

This author is not afraid to grasp the nasty nettle that lurks within demographic descriptions when thinking about domestic workers: the role of immigration in filling these jobs. She's not at all reticent about stating the obvious: our country and economy needs and benefits from these foreign-born workers.

Immigration issues are inseparable from the issue of caregiving. ... Foreign-born women coming to the United States to provide caregiving are part of a larger pattern of international labor migration. Because farming no longer provides a sustainable livelihood in parts of the globe where it was once the primary means of survival, people there are forced to leave and find work in industrialized nations. ... Today it is difficult to imagine how the country would function without immigrants. Immigrants grow, harvest and package our food; they drive us to the airport, pump our gas, and serve and clear away our food in restaurants. They take care of the most precious elements of our lives -- our homes and families.

...between replacing retired workers and new workforce growth in the coming decades, we'll need more than 82 million people entering the workforce. Thirty-five to 40 percent of that workforce will have to come from first- and second-generation immigrants.... In fact, we are counting on immigrants not only to fill jobs as the baby boomers retire but also to buy houses, to buy other goods and services, to accumulate wealth, and to pay taxes.

The truth is, the diverse and growing aging population and the growing immigrant population in this country need each other. We have three times more families in need of care providers than our current workforce is able to support. There is no way to meet our need for care in this country without immigrants carrying a lot of the weight.

She believes the increasing population of elders, their families and friends, and their care-givers can form what she calls a "Caring Majority."

The task of building a more caring economy and a caring nation means we have to come together across differences in race, culture, class and generations in ways that this country has never seen. ...We have to engage all of the communities that are impacted by the elder boom: care workers, senior groups, disability rights advocates, women's organizations, unions, communities of faith, youth and students. This is the Caring Majority....I believe we have a Caring Majority in the United States; it's who we are -- who we were meant to be -- and it can provide the base of our power as we work together to create broad, accessible solutions that can work for all of us.

Poo clearly cares about elders. And she's heard the message that nearly all of us, given the chance to envision the context in which we'd prefer to age and die, want to stay in our homes as much as possible. She's trying to describe how that might be more possible, without either burning out our family members (if we have any) or taking advantage of the desperation of poor women forced into lousy, isolating jobs. She makes it believable that we could do better.

Yet somehow, the voices of elders themselves -- the people who need the Caring Majority most -- are the least heard in Poo's stories. I don't think we'd disagree with much (I certainly wouldn't) but the mushrooming elder constituency isn't likely to keep silent during the elder boom. Poo needs to incorporate our voices more audibly as well.

I'll close this with one more inspirational tidbit from an inspirational book:

Let's remember: people getting older is not a crisis; it's a blessing. We're living longer; the question is how we should live. As a country, we have to figure out how to embrace this demographic shift with grace.

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